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`SUP.PLEMENT io plleb Apps::
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> `PROPERTY OWNER:INFORMATION s
<br /> �, .. � , __ .. �,- tT:- Cu TOMER TO PROVIDE
<br /> OWN jM /
<br /> © > '-fi L 7/ C ke r Q 4,ening Status; CUP;
<br /> OOWIIJER•DD ES ( uu ber,St�rejet,Ci ,State,Zip) j ( { / Deed Restriction;CSM
<br /> 7 9 V1>'L'<S�I / (�°�ii-& kg'
<br /> d ar51,41) W16G �3 s3-9 (Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ,
<br /> 46845:5117g7 Co.• - '
<br /> a?.?Q �idh� N d 0 !'►'( , U v- NISfite Plan drawn to scale
<br /> _AGENT'1NFORMATIO N CONTRACTOR;INFORMATION, ,?° s,s and includes dimensions
<br /> •AGENT NAME CONTRACTOR NAME
<br /> ()o h Z.Qa ( CLe4rY sodding C orp. [ itg Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS J ofWell/septic •
<br /> SRC>✓Le c�S _ • P0. aox`].302.2.d t/erortie►W1S Sjs'6 etbacks
<br /> (City,Stale,Zip) (City,State,Zip) . l
<br /> CEO 6P8 `l TO- 031 46ff9ler'/7"/-4,14 i73-Crft)
<br /> PHONE PHONE ❑Site Plan royal from
<br /> - ajcplica township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS '
<br /> Floor plat to scale
<br /> `PROPERTY/LOCATION INFORMATION (http/laccesdane co.dane wi use r ? T Elevatio of property
<br /> PARENT PARCEL NUMBER: } CU ENTZO ING ACREAGE . f P P rtY
<br /> ❑N MBER oRf& -3J�"' S.S'o-L �f . /p)( 6s fron 3g drawn to scale.•
<br /> TOWNSHIP: SECTION:
<br /> 1 +
<br /> - -o w Y. Q-t Pile 41 (no.- 3 %4: 3,'�, ,%<: V N,
<br /> ❑Driveway its
<br /> ADDRESS: (( (state unty, ••,n)
<br /> 9 we 54 I CcIl►la 7ti Mar5 .a1( w(S 0 55Y ❑Sanita •ermits
<br /> CSM: 4 n a LOT t SUBDIVISION BLOCK/LOT
<br /> [ f (pub' ,private)
<br /> •
<br /> PROPOSED.,PROJECT INFORMATION -- __- . , - :, i -`_� �:TiA�'F RE-uIEW t� {•
<br /> PROJECT DESCRIPTION: tY+44lti t N e $�(ed ~ 4 s?A x '-' ` �`
<br /> AJd t-4'tan lr¢ q2 x a 7 X'if 1 o ex t s{-i,is bwllitn t `El ontng Dlstnct s `
<br /> This project is a new building or structure sF'�` `` �"
<br /> • ❑ P 1 g Pertnitfei a?,,tIk f
<br /> This project is an addition/a)ration to an existing building or structure. t'"IM '' .-_ r r `4 SANITARY SERVICE: / PERMIT NUMBER Rur'aai •res:. _:4•..• ,,--..--;,,,, ,{ r
<br /> �Evv R EP11C / `J / r (ne 7e Isbn-•
<br /> 111 z"L4 1 'k▪^whC
<br /> HEIGHT IN FEET . NUMBER OF STORIES: (Not including basement) ,
<br /> ) ,t:® Wetland/ odpIaln/
<br /> ^-4''SFior nd atac en :4,7,....;
<br /> AREA TO NEAREST SQUARE FOOT: T _4� , ,t ,w I-,' r'.„.7:01.:0714:1K:21.i .,.��-
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) T arm r w�v :� 'r
<br /> `❑ EroslooC• of petmlt'
<br /> BASEMENT 1ST FLOOR: 13 L j ; ''."fie"' r.'+,,v rZ^ +�, -�
<br /> 7J 4,TOTAL SQUARE FOOTAGE: ,j, -� :slope •Isturbance ,
<br /> / fi l • c es tsi h
<br /> 2ND FLOOR 3RD FLOOR: ) �n£"� r• " ��
<br /> 3 1 7-R,evleWebtaticg S vey t x
<br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ v and a allab eo)ttio s 3 r
<br /> (Please round to nearest dollar) dpQ _: 544_-..tea , -s.i
<br /> • 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Y slo ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? 'es alo Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? Wes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - Wes ❑No,f
<br /> • 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank it'none) .
<br /> 6. Is a location survey required? (see reverse) ❑Yes 4o Don't know
<br /> 7. Is this to correct a violation?- ❑Yes ao
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -■. ■ -►
<br /> 545-112(4109) . -
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